Obama confident health care reforms will survive state challenges

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The White House is dismissing the threat of nearly two dozen legal challenges from the states against President Obama's health care reforms, equating its defense of mandatory health insurance with landmark court fights over civil rights and Social Security.

"This is nothing new," Stephanie Cutter, assistant to the president for special projects, said on the White House blog.

"We saw this with the Social Security Act, the Civil Rights Act, and the Voting Rights Act - constitutional challenges were brought to all three of these monumental pieces of legislation, and all of those challenges failed," Cutter said.

A Pensacola, Fla., judge last week ruled that a case brought by 20 states challenging the constitutionality of health care reform can go forward. A separate lawsuit is progressing in Virginia.

At issue in most of the cases is the so-called individual mandate, and whether Congress has the right to compel consumers to buy insurance or face a government penalty.

Under the 10-year, $938 billion law passed by Congress and signed by Obama in March, those without insurance would face penalties of $95 or 1 percent of his or her income, whichever is higher, in 2014. The annual penalty increases in 2016 to $695 for an adult or up to $2,085 per household, or 2.5 percent of income, whichever is higher.

Those exempted from the requirement include the very poor, American Indians, the incarcerated, and those who refuse on religious grounds, among others.

Ilya Shapiro, a constitutional scholar at the Cato Institute, predicted the U.S. Supreme Court will ultimately decide the matter, but, because of the lengthy appeals process, it likely won't be decided until just before the 2012 presidential elections.

"At this stage I am cautiously optimistic," said Shapiro, whose institution filed two briefs supporting Virginia's challenge of the law. "At this point the courts are saying the plaintiffs are bringing serious charges, it is heartening."

Some states argue that the law significantly expands Medicaid coverage and amounts to an unfunded federal mandate that will further stress cash-strapped state budgets. The Justice Department maintains that Congress was within its power in passing the sweeping reform measure, Obama's most significant legislative accomplishment to date.

A judge in Michigan recently threw out a similar challenge to the law. Cutter noted that the Michigan judge observed that those who opt out of buying insurance often end up in the hospital anyway -- with the cost passed on to the care provider, the insured or the government.

Despite numerous legal challenges, the federal government is implementing the Affordable Care Act on schedule.

Provisions allowing parents to keep children on their policies until the age of 26, easing preventative care costs for mammograms, flu shots and other procedures, and a ban on the practice of canceling coverage for pre-existing conditions are already in place.

In addition to legal remedies, health care reform is likely to face a repeal effort if Republicans make big gains in Congress next month.